Motivating People for Better Health

Will the new food label work? Check below for AFAA CEU Corner

by Shari Portnoy, MPH, RD, CFT

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Food labels are about to change. These labels on retail packages, a required outcome of the Nutrition Labeling and Education Act of 1990, have to meet strict guidelines and regulations set by the U.S. Food and Drug Administration (FDA). The extensively detailed laws and regulations were originally enacted in order to assist consumers in making healthy choices. Has the food labeling initiative met its goal? More than one-third of U.S. adults (over 72 million people) and 17% of U.S. children are obese. From 1980 through 2008, obesity rates doubled for adults and tripled for children.(1) During the past several decades, obesity rates for all population groups—regardless of age, sex, race, ethnicity, socioeconomic status, education level or geographic region—have increased greatly. These statistics may show that people either don’t read the food labels, lack the knowledge to understand food labels or simply don’t care (i.e., the initiatives aren’t working). This should indicate a drastic overhaul for a new food label—not so! The new label looks remarkably similar and some say the overhaul is really just a few detail changes on the same old thing.

This article will look at the research, or lack thereof, that put food labeling laws into existence. Upcoming proposed changes and some alternatives to the food label will be discussed to determine if the food labeling laws will really motivate people to make healthy choices.

Research Studies 
The FDA reviewed over 40,000 comments before the food labeling laws took effect 20 years ago. Observations from food companies, manufacturers and individuals are what led to the Nutrition Facts Panel we see on packing today. Most comments covered nutrients and design graphics, but lacked mention of motivating factors.

Surprisingly little research has been performed to determine if food label reading leads to healthier choices over any time period. The largest research study on food labels in 2013 included only 9,000 subjects. The study premise was to determine if people can identify healthier choices based on wording and serving size.(2) The study concluded that people can, in fact, use the Nutrition Facts Panel to identify healthier foods. The authors determined this by asking consumers to look at several label formats with words and portion sizes displayed in diverse ways. This should be a first step in figuring out how food labels and laws will work toward decreasing the obesity rate. No other research studies were found in defense of making a food label that could contribute to a decline in the growing obesity rate. There is no peer-reviewed research or longitudinal study on the effects of the food label.

When asked about the food label and the outcomes for obesity, the FDA commissioner said in February 2014, “The Nutrition Facts label is one tool to help consumers make informed food choices and maintain healthy dietary practices.”(3) She went on to say that the label may encourage food manufacturers to make products with reduced-fat, reduced-sodium, etc. Further explaining that the new food label is based on extensive examination of the latest public health trends and research on nutrition and disease, she said nothing about motivation. These scientific facts seem to have no bearing on consumer behavior, emotions, finances and priority for losing weight in their lives. Therefore, showing facts on a label is determined by statistics, not by who will use them. According to Dr. Lo, the premier researcher on food labels and behavior, educated females with health concerns are the population that uses food labels most.(4) Has this been taken into account by the FDA in proposing the new label?

The label changes are based on science and research, but science and research are not the determinants of who will be motivated to use the nutrition label to practice healthy choices.(1) An article in the Journal of Consumer Affairs, which is not a health journal, did a study and concluded that label users who did not exercise displayed a slightly greater likelihood of weight loss than those who exercised but did not read labels (5)—more perplexing information given to those who are tasked with creating a label that will impact health.

Michael R. Taylor, the FDA deputy commissioner for foods said, “Over half of Americans use the label on a regular basis.”(1,3) However, is the population that uses them the same one that makes healthy choices regardless of the label? The Federal Register (6) reports that the new food label corresponds to new information on consumer behavior and consumption patterns, but considering the lack of data on this subject, there is little evidence to support Taylor’s words.

Other Ideas Besides Food Labels
The food label, or Nutrition Facts Panel, isn’t the only system to determine the nutritional value of the food you buy. A few company-based (versus government-based) systems developed strategies to show nutritional value. Just like the food label though, they are scientific systems, not behavior modification systems.

Nutrient profiling is one method used to classify foods based on nutrient composition. NuVal® is one such system.(7) NuVal scores foods from 1 to 100 based on 30 different nutrients, with 100 connoting the healthiest. Developed by a team of doctors and experts at Yale’s Griffin Hospital, it is based on the ONQI® (Overall Nutritional Quality Index), the most common type of nutrient profiling system. The numbers, which appear on price tags in certain stores, are meant to positively affect food purchase patterns that correlate to health outcomes.(8) Data reported in the American Journal of Preventive Medicine (9) showed that foods with a high score on the ONQI are associated with modestly lower risk of chronic disease. But just as with the nutrition label, there is no indication that a system like this will lead consumers to use grocery purchasing power for better health. This tool can be used by food manufacturers to highlight healthy food options, but if consumers lack motivation to use it, nothing is accomplished.

Nutritional profiling, another approach, has been studied as a systematic and feasible method for categorizing foods not only for health, but for financial consideration as well. Organic cereal is one example. A study in the Journal of Public Health using nutrient profiling reported that organic cereal and non-organic cereal have the same nutrient profile.(10) Although the food label also shows this information, it is more pronounced with nutrition profiling.

Another method of displaying nutrition facts for consumer use is store signage. The Robert Wood Johnson Foundation funded a study on signage through its Healthy Eating Research program. They put out signs in stores about sugar sweetened beverages showing the amount of miles you need to walk in order to burn off the calories in certain sugary drinks. They collected purchase data on teens who bought drinks and found that after the signs were posted, there was a drop in purchase of sugar sweetened beverages. In addition, the authors reported that the teens continued to make healthier choices weeks after the signs were removed.(11) This study suggests that you can encourage behavior change, something that wasn’t tabulated when creating the new FDA food label. 

A health impact assessment is yet another way to show the health properties of foods. This kind of evaluation is a “combination of procedures, methods and tools by which a policy, program or project may be judged in terms of its potential effects on the health of a population, and the distribution of those effects within the population.”(15)

Los Angeles County performed a health assessment on restaurant food labeling because, despite the growing interest in menu labeling, they didn’t find studies to quantify the potential impact of this strategy on the obesity epidemic. Their findings suggest that, even with only modest changes, the impact of menu labeling on population weight gain could be substantiated.(12) The assessment didn’t distinguish which types of people (i.e., obese versus healthy weight) would choose the healthier items based on menu labels.

While there are a variety of techniques to compare foods for health, there isn’t much data to show a positive outcome. More studies need to be performed on who is actually reading and understanding the labels while using the systems in place. 

The New Food Label
Taylor says the FDA is hopeful the labeling changes will help people make healthier choices.(1) According to FDA data, the amount of people who use food labels rose by 10% from 2002 to 2008.(13) Although two-thirds of those who read labels stated they did so to get a general idea of the nutritional content of the product, no study was performed to see if people know what is really healthy versus what they perceive as healthy. Based on this information, and updated science, a new food label will appear in two years. The three key proposed label changes include:

1. Mandatory listing of added sugars,
2. Larger size type and format for listing Calories, and
3. Amended definition of single-serve containers to show what is customarily consumed in one sitting.(6)

These changes are intended to assist people in understanding how many calories and nutrients they are getting if they eat or drink a certain amount of food at one time. Since the origin of the Nutrition Facts Panel, the food industry has been introducing more whole grains and choices with fewer nondesirable ingredients such as sugar and fat. Still, there has not yet been a correlation between the obesity rate and healthier foods on the shelves. According to Academy of Nutrition and Dietetics,(2) the new label will make it easier for people to access and identify calorie information. However, if the people looking for data are the same ones who are currently reading labels, will the new labels make any strides in the obese population that isn’t reading them? According to a 1995 report in the Journal of Consumer Affairs,(14) in addition to formulating food labels, educational programs need to be implemented along with evaluations of the health benefits of using food labels. With all the work put into creating this new label, why wasn’t this study updated or taken into account?

In Conclusion
The food label has readers but reading doesn’t always lead to action. More research needs to be compiled on consumer motivation for health in conjunction with consumer knowledge. The FDA label overhaul will require manufacturers to implement these changes in two years, though this won’t make a dent in the obesity epidemic if it just adds and subtracts words and graphics and doesn’t focus on the underlying problem. AF

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Shari Portnoy, MPH, RD, CFT, is a Registered Dietitian and Certified Fitness Trainer. She holds degrees in both nutrition and public health and has completed the U.S. Food Laws course at the Michigan State University Institute for Food Laws and Regulations. A featured speaker at the American Culinary Federation National Convention, Portnoy is a published author and regular contributor to many websites. She has served as the food safety expert for CNN and Anderson Live.

REFERENCES

1. “PROPOSED NUTRITION FACTS LABEL CHANGES ARE BASED ON SCIENCE AND RESEARCH.” (FEB 27, 2014). WWW.FDA.GOV/FORCONSUMERS/CONSUMERUPDATES/UCM387164.HTM (ACCESSED JAN 7, 2015).

2. LANDO, A.M. AND LO, S.C. “SINGLE-LARGER-PORTION-SIZE AND DUAL-COLUMN NUTRITION LABELING MAY HELP CONSUMERS MAKE MORE HEALTHFUL FOOD CHOICES.” JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS, 113, NO. 2 (FEB 2013): 241-50.

3. JIN, J. “FDA PROPOSES FOOD LABELING CHANGES TO UPDATE SERVING SIZES, HIGHLIGHT CALORIE CONTENT.” [email protected] FEB 27, 2014. NEWSATJAMA.JAMA.COM/2014/02/27/FDA-PROPOSES-FOOD-LABELING-CHANGES-TO-UPDATE-SERVING-SIZES-HIGHLIGHT-CALORIC-CONTENT/ (ACCESSED JAN 12, 2015).

4. LO, D.R.. “FOOD LABELING ON FOOD CHOICES.” LECTURE, NUTRITION AND THE BRAIN, NEW YORK ACADEMY OF SCIENCES, NEW YORK, MAR 26, 2014.

5. BIDISHA, M. “USE OF FOOD LABELS AS A WEIGHT LOSS BEHAVIOR.” THE JOURNAL OF CONSUMER AFFAIRS, 44, NO. 3 (2010): 516-27.

6. “FOOD LABELING: REVISION OF THE NUTRITION AND SUPPLEMENT FACTS LABEL.” (MAR 3, 2014). WWW.FEDERALREGISTER.GOV (ACCESSED JAN 8, 2015).

7. FAQS THE NUVAL® SYSTEM. (JAN 1, 2013 ) WWW.NUVAL.COM (ACCESSED JAN 12, 2015).

8. KATZ, D., ET AL. “THE STRATIFICATION OF FOODS ON THE BASIS OF OVERALL NUTRITIONAL QUALITY: THE OVERALL NUTRITIONAL QUALITY INDEX.” AMERICAN JOURNAL OF PREVENTIVE MEDICINE, 24, NO. 2 (NOV/DEC 2009): 133-43.

9. CHIUVE, S.E., SAMPSON, L. AND WILLETT, W. “THE ASSOCIATION BETWEEN A NUTRITIONAL QUALITY INDEX AND RISK OF CHRONIC DISEASE.” AMERICAN JOURNAL OF PREVENTIVE MEDICINE, 40, NO. 5 (MAY 2011): 505-13. 

10. WOODBURY, N.J. AND GEORGE, V.A. “A COMPARISON OF THE NUTRITIONAL QUALITY OF ORGANIC AND CONVENTIONAL READY-TO-EAT BREAKFAST CEREALS BASED ON NUVAL SCORES.” PUBLIC HEALTH NUTRITION, 17, NO. 7 (2014): 1454-58.

11. UNIVERSITY OF CONNECTICUT RUDD CENTER FOR FOOD POLICY & OBESITY. “EASY-TO-READ CALORIE INFORMATION REDUCES TEENS’ SUGARY DRINK PURCHASES.” THE RUDD CENTER HEALTH DIGEST. (OCT 1, 2014). WWW.YALERUDDCENTER.ORG/NEWSLETTER/ISSUE.ASPX?ID=74 (ACCESSED JAN 8, 2015).

12. KUA, T., ET AL. “MENU LABELING AS A POTENTIAL STRATEGY FOR COMBATING THE OBESITY EPIDEMIC: A HEALTH IMPACT ASSESSMENT.” AMERICAN JOURNAL OF PUBLIC HEALTH 99, NO. 9 (SEP 2009): 1680-86.

13. HAMBURG, M. “PLANNING HEALTHY CHANGES TO THE NUTRITION FACTS LABEL.” FDA VOICE BLOG. (FEB 27, 2014). BLOGS.FDA.GOV/FDAVOICE/INDEX.PHP/2014/02/PLANNING-HEALTHY-CHANGES-TO-THE-NUTRITION-FACTS-LABEL/ (ACCESSED JAN 12, 2015).

14. WANG, G., FLETCHER, S. AND CARLEY, D. “CONSUMER UTILIZATION OF FOOD LABELING AS A SOURCE OF NUTRITION INFORMATION.” THE JOURNAL OF CONSUMER AFFAIRS, 29, NO. 2 (1995): 368-80.

15.  EUROPEAN CENTRE FOR HEALTH POLICY. “HEALTH IMPACT ASSESSMENT: MAIN CONCEPTS AND SUGGESTED APPROACH.” GOTHENBERG CONSENSUS PAPER. 1999.

OTHER SOURCES

ACADEMY OF NUTRITION AND DIETETICS. “CAN CHANGES IN NUTRITION LABELING HELP CONSUMERS MAKE BETTER FOOD CHOICES?” (JAN 13, 2013) WWW.EATRIGHT.ORG (ACCESSED JAN 2, 2015).

ARSENAULT, J.E., ET AL. “A NOVEL APPROACH TO SELECTING AND WEIGHING NUTRIENTS FOR NUTRIENT PROFILING OF FOODS AND DIETS.” JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS, 112, NO. 12 (DEC 2012): 1968-75.

ASCHEMANN-WITZEL, J., ET AL. “EFFECTS OF NUTRITION LABEL FORMAT AND PRODUCT ASSORTMENT ON THE HEALTHFULNESS OF FOOD CHOICES.” APPETITE, 71 (DEC 1, 2013): 63-74.

 “HOW TO UNDERSTAND AND USE THE NUTRITION FACTS LABEL.” OCT 29, 2014. WWW.FDA.GOV/FOOD/INGREDIENTSPACKINGLABELING/LABELINGNUTRITION/UCM274593.HTM (ACCESSED JAN 12, 2015).

KATZ, D., ET AL. “PERFORMANCE CHARACTERISTICS OF NUVAL AND THE OVERALL NUTRITIONAL QUALITY INDEX.” AMERICAN JOURNAL OF CLINICAL NUTRITION ,91, NO. 4 (APR 2010): 1102S-08S.

LOBSTEIN, T. AND DAVIES, S. “DEFINING AND LABELLING ‘HEALTHY’ AND ‘UNHEALTHY’ FOOD.” PUBLIC HEALTH NUTRITION, 12, NO. 3 (MAR 2009): 331-40.

POMERANZ, J.L. “A COMPREHENSIVE STRATEGY TO OVERHAUL FDA AUTHORITY FOR MISLEADING FOOD LABELS.” AMERICAN JOURNAL OF LAW AND MEDICINE, 39 (2013).
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